Testicular cancer therapy can threaten a man's fertility. Learn the steps to take to help increase your odds of becoming a father.

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Testicular cancer treatments can rob a man of his fertility. But that doesn’t mean survivors can’t have a biological family. Doctors are finding ways of killing the cancer and protecting fertility at the same time. Still, the key in many cases is to make arrangements before beginning cancer treatment.

Testicular cancer is relatively rare and highly curable, especially when caught early. According to the American Cancer Society, the risk of dying of this cancer is 1 in 5,000. However, it is the most common type of cancer for teenage boys and young men ages 15 to 34, and preserving fertility is especially important for this age group.

Edmund Sabanegh, MD, director of the Cleveland Clinic Center for Male Infertility in Ohio, says 75 percent of men who have not had children are concerned that their
testicular cancer treatment may cause infertility. The good news, according to Dr. Sabanegh: “We can keep most men fertile.” And sperm banking before treatment begins can act as an insurance plan, in case your ability to make sperm is destroyed during treatment.

Testicular Cancer and Infertility: Sperm Banking

Sperm banking involves harvesting and then freezing sperm at very low temperatures (your home freezer won't work). When the time is right, your partner undergoes artificial insemination to conceive a baby. Frozen sperm can last decades, if not longer.

Sabanegh believes banking sperm “will really save you a lot of emotional grief and expense later.” He urges more doctors to educate their cancer patients about sperm banking.

When a young man is under the age of 18, it may be up to his parents to start the conversation. Sabanegh admits this may be a delicate discussion, but notes he has patients who are now in their twenties who are “upset and disappointed” that they did not bank sperm.

Testicular Cancer and Infertility: Radiation and Chemotherapy

Even though doctors will remove the cancerous testicle, the other usually remains healthy and able to produce enough sperm to father a child.
Radiation and
chemotherapy are the two real hazards to a man’s fertility. But modern medicine has come up with ways of increasing your odds of having a baby “the old-fashioned way.”

If you need radiation, doctors can guard fertility by carefully adjusting doses and using special devices to shield the healthy testicle. The newest machines can pinpoint their beams and produce less "scatter" that can affect fertility, says Sabanegh.

It may take as many as two years to get fertility back, but “the vast majority will recover sperm counts, it just takes time,” he says.

Chemotherapy can also damage a man’s ability to make sperm. Some drugs are more damaging than others. Sabanegh says adjusting doses and combining drugs can protect fertility in some men, while killing the cancer cells. Still, it will take some time to get your fertility back.

Testicular Cancer: Put Baby Plans on Hold

Sabanegh advises that testicular cancer patients should delay fathering a child for at least a year after treatment with chemotherapy or radiation. “Both chemotherapy and radiation cause DNA breaks in the sperm which can theoretically create abnormal embryos.” But, he adds that studies have not shown a greater instance of birth defects in babies of men who have had chemotherapy or radiation. “The sperm may be so damaged that no conception occurs in the first place,” Sabanegh says.

Testicular Cancer: Another Threat to Fertility

Some testicular cancer patients will need lymph nodes removed from the back of the abdomen because they are cancerous or might be cancerous. This operation is called a retroperitoneal lymph node dissection (RPLND). Unfortunately, during this surgery the nerves responsible for ejaculation can be severed. The result is retrograde ejaculation, where sperm enters the bladder instead of exiting out of the penis. Here are your options if this occurs, according to Sabanegh:

High-dose pseudoephedrine can help create a normal ejaculation. Your doctor will tell you how much to take and when.

Recovering sperm. Sperm can be recovered from the bladder, but you may have to take medication so your urine doesn’t kill the sperm.

A new surgical technique called nerve-sparing RPLND is now available. This allows doctors to carefully operate around the nerves and save normal ejaculation. Not every urological surgeon in every hospital can perform this delicate surgery, so you may have to travel to a major medical center to get it. Sabanegh says 95 percent of men who have this type of RPLND report no problems.

Testicular Cancer and Infertility: Hope on the Horizon?

Cancer researchers and fertility experts are busy investigating new ways of helping cancer survivors have babies. One method involves freezing sperm-forming stem cells that later can be implanted into the testicle. Sabanegh says this could “reseed the testes” and effectively “restart the sperm factory.” This has shown promise in animal research, he adds.

The National Institutes of Health is funding a program called the Oncofertility Consortium to help cancer patients with fertility issues.

Thinking about your future family might be the last thing on your mind when faced with a testicular cancer diagnosis. But in the long run it’s very important — after all, with the proper treatment, the odds are good you will survive the cancer. Being fully prepared and educated about your options before you seek treatment for testicular cancer will improve your chances of preserving your fertility.

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